The American Association of Diabetes Educators (AADE) is a multi-disciplinary professional membership organization of over 13,000 health professionals dedicated to improving diabetes care through education. At their annual meeting held Aug 11-14, 2016 in San Diego, CA, Dr. Tia Rains of ENC sat down with Jill Weisenberger, Certified Diabetes Educator and Registered Dietitian Nutritionist to discuss key takeaways from the annual meeting, the challenges of living with diabetes, what the future may look like in designing optimal diets for people with diabetes.
ENC: Can you please describe what it means to be a Certified Diabetes Educator?
Jill: A Certified Diabetes Educator, or CDE, is a health professional who is experienced in teaching people how to self-manage their diabetes. Typically, CDEs are registered dietitians, nurses, social workers, pharmacists, physical therapists, physician assistants or physicians. To sit for the certification exam, one must complete 1,000 hours of direct experience with diabetes education and self-management. A CDE is trained in all areas of diabetes self-management, including diet, foot care, eye care, medications, and blood glucose monitoring. As such, they can provide comprehensive education to patients on how to successfully live with diabetes.
I enjoy being a CDE because I am able to address the total person, not just the dietary component. The reality is that diabetes is not just a disease of blood sugar. Diabetes affects multiple body systems and having an understanding of the totality of the disease is key to teaching self-management to patients.
ENC: What are the primary challenges you face in working with patients with diabetes?
Jill: Most patients only want to focus on two numbers: blood sugar and body weight. But the reality is that having diabetes increases your risk of having cardiovascular disease (CVD) or a heart attack two-four times. In women, a diagnosis of diabetes removes the protection against heart disease that comes with being female. Risk of certain cancers also greatly increases with diabetes. It’s challenging to get people to realize that they cannot focus only on those two numbers, that they need to consider reducing their risk for other diabetes-related comorbidities.
Another challenge is that diabetes is a progressive disease, yet most patients don’t realize this. The treatment plan has to match the stage of the disease, match the age of the person, and risk or management of other health conditions (e.g., CVD). A treatment plan that worked 10 years ago is unlikely to work for them now. And a plan that worked for another person, may not necessarily work for them.
ENC: What is your approach to designing diets for your patients?
Jill: I tell everyone that there’s more than one way to build a healthy eating plan for diabetes management and I’m going to help you find what works for you. Nutrition can be flexible and tailored to individual needs. But many people want to be told exactly what to eat and not to eat. So I have to explain how to build meals that not only work for their diabetes, but also meals that provide the nutrients and phytochemicals to reduce the risk for diabetes-related conditions such as certain types of cancer and heart disease.
ENC: How do eggs fit into your practice?
Jill: I love eggs because they’re low in carbohydrate, relatively low in calories for people trying to lose weight, and nutrient packed. They are easy to cook and based on my experience, most people are comfortable cooking eggs. People are also looking for foods they can carry with them. I tell people they can make hard-boiled eggs on Sunday for use during the week.
ENC: As you’re aware, the Dietary Guidelines for Americans have evolved over the past 20 years with the recent 2015-2020 recommendations focusing more on dietary patterns and less on individual nutrients. Have recommendations for individuals with diabetes followed suit or are there still nutrients of concern for this population?
Jill: Halleluiah! I’m so happy that we’re now talking about dietary patterns and not individual nutrients. The American Diabetes Association (ADA) actually embraced the dietary pattern approach several years now. But many patients are not there yet. They still are in the mindset of nutrients that are good and nutrients that are bad and foods that are good and foods that are bad. Sadly, it sets them up for feelings of guilt.
The ADA guidelines do call out saturated fat and sodium as nutrients of concern. But I rarely do any calculations on these nutrients to ensure they’re below the limits. I just help people make better choices to improve their overall eating pattern to be consistent with the recommendations of ADA and now, the Dietary Guidelines for Americans.
ENC: Any emerging trends or surprises in the field of diabetes or learnings from the AADE annual meeting?
Jill: The artificial pancreas might be available in another year or so. This is a big deal for people with type 1 diabetes. It seems like there is always something new with technology. For example, smart meters that are linked via the cloud to CDEs around the country. They can monitor individual patients, look at their blood sugar levels and make recommendations from anywhere. We are also learning more about the types of metabolic defects in type 2 diabetes. Several years ago, we thought the problems were entirely with the liver, pancreas and muscle cells – just three organs in the development of type 2 diabetes. Then researchers discovered that there were eight players. Just recently, scientists have added three more players to the list. We are now looking at 11 problems – some injure the beta-cells of the pancreas and others are the result of this injury.
ENC: Where do you think the future lies regarding diet and diabetes risk and management?
Jill: I think we’ll talk more about dietary patterns than individual foods. More liberal diets and less prescriptive diets. And there’s more and more talk about prediabetes. So much opportunity to intervene which can at least delay, if not prevent, the onset of diabetes for years or decades. Diet and lifestyle are extremely effective in this regard. And people are becoming more aware of prediabetes, although currently, 86 million people have prediabetes but only 10% have been diagnosed.